Antiretroviral therapy for prevention of HIV transmission: implications for Europe

Abstract

The aim of this review is to summarise the evidence on the population-level effect of antiretroviral therapy (ART) in preventing HIV infections, and to discuss potential implications in the European context of recommending starting ART when the CD4 count is above 350 cells/mm 3 . The ability of ART to reduce the risk of HIV transmission has been reported in observational studies and in a randomised controlled trial (HPTN 052), in which ART initiation reduced HIV transmission by 96% within serodiscordant couples. As yet, there is no direct evidence for such an effect among men having sex with men or people who inject drugs. HPTN 052 led international organisations to develop recommendations with a higher CD4 threshold for ART initiation. However, there remains a lack of strong evidence of clinical benefit for HIV-positive individuals starting ART with CD4 count above 350 cells/mm 3 . The main goal of ART provision should be to increase ART coverage for all those in need, based on the current guidelines, and the offer of ART to those who wish to reduce infectivity; increased HIV testing is therefore a key requirement. Other proven prevention means such as condom use and harm reduction for people who inject drugs remain critical.

Implications for a policy of initiating antiretroviral therapy in people diagnosed with human immunodeficiency virus: the CAPRA research programme

“…2 Antiretroviral therapy (ART) is now highly successful in reversing the effects of HIV and has led to death rates in successfully treated people that are not much greater than those of the general population. 3,4 Given that there are reductions in infectivity of people on ART, 5 there is widespread interest in the potential effect of ART in controlling the HIV epidemic, 6 but there are a number of areas, including the UK, in which ART use is high among MSM, and yet incidence has not declined [7][8][9][10] and its potential impact in epidemics in MSM has been questioned. 9,11 In the Comprehensive Assessment of the Prevention Role of Antiretroviral therapy (CAPRA) programme of research that started in 2010 we set out to address what would be the population-level clinical effectiveness, and cost-effectiveness, of introduction of a policy of initiating ART in all people with a diagnosed HIV infection.…”

Factors associated with condom use and HIV testing among young men who have sex with men: a cross-sectional survey in a random online sample in Sweden

“…Two important aspects of sexual health behaviour thus are using protection for intercourse, and regular HIV testing to ensure prompt treatment 2. Though nowadays, antiretro virals and pre-exposure prophylaxis (PrEP) are viable ways of protection against HIV infection,3 the focus of this article is condom use for anal intercourse.…”

HIV-1 transmission networks in high risk fishing communities on the shores of Lake Victoria in Uganda: A phylogenetic and epidemiological approach

“…Global health initiatives have led to a reduction in HIV transmission at population level [1]. However, sub-Saharan Africa still accounts for 70% of the global total of new HIV infections [2].…”